Trigger Me Not

Eight Tips to Fight Through Trauma and Get Healthcare

Last Saturday I received a text at 2.17 am. “Hey Kelly” said the Friend Of A Friend, who misspelled my name because we don’t know each other well, “got a minute?”

The FOAF then sent a series of texts describing a medical problem involving pus and a body orifice; a problem that obviously needed immediate medical attention. When I responded “Who is with you right now? You need to go the ER” I knew what was coming next.

“Um, I don’t really do medical stuff. I’ve had some bad stuff go down in the hospital.”

I screamed “what is wrong with my people!” into my pillow and text-talked the FOAF into an action plan. With treatment, they are doing fine now, with absolutely no green pus coming out of any orifices.

The answer to my muffled question was, of course, nothing is wrong with us. But many of us in the LGBT community has been ignored, misunderstood, mischaracterized and treated like poo during interactions with the health care system. Now we’re angry, sad, disgusted, scared and-- most of all--traumatized and want to avoid situations that make us re-experience all those feelings.

There’s nothing illogical about that.

Unfortunately our perfectly reasonable abhorrence of health care doesn’t make us need health care any less. How can we fight through our trauma to get the care we need?

1. Brainwash yourself into a Healthcare Entitlement Zone

Because our healthcare system is substantially broken, getting good healthcare is a fight for everyone, with the possible exception of the Super Duper Rich. So if you’re not Super Duper Rich, and you’re not a heterosexual, it can be a battle to get what you need. Add some queer body issues, some gender stuff going on? The battle becomes a war.

Alas, in order to fight for care, you must first be convinced that you deserve care. Your partner can believe it and encourage you, that’s awesome. Your friends can believe it, and that helps too.

But at the proverbial end of the day (meaning in this case the beginning of the appointment) you must be the one to believe, my friend.

Say it with me: “I deserve health care”

Even if you haven’t had a pelvic exam in ten years

You deserve health care

Even if you have a chronic problem that you’ve been ignoring.

You deserve health care.

Even if you’ve let that simple problem go until you’re shooting green pus out of an orifice .

You deserve health care.

Buy a pack of three by five cards and write “I deserve health care” on every single solitary one. Paper your walls with them. Put them inside your favorite books. Tape them on the bottles of soda in the refrigerator. Freeze them into your ice cream trays.

Just keep saying it until you believe it. For yourself.

2.. Pick the least extreme medical location that can appropriately treat what’s going on for you.

If you have trauma that makes it hard to get medical care, you need a relatively relaxed provider who has some time to spend with you. That’s why the emergency room sucks when you have a problem that isn’t an actual emergency: you get over-tested, under-treated, rushed and often re-traumatized.

Even if you’re uninsured, there are places you can get care for non emergency problems, including free clinics, sliding scale providers, clinics associated with medical schools, etc. Often Federally Qualified Health Centers in your area can also be of service.

Of course, in order to use one of these places, you need to take care of the problem before it becomes an emergency.

I know, I know. See tip number one.

3. Use Your Words

If your fight or flight reaction kicks in when a provider attempts to do a physical exam, a sensitive provider might guess why you’ve become physically unable to cooperate. Maybe.

But it’s better for everyone if you can have a conversation about it beforehand. Meaning, before anyone touches your body. Definitely before you have your clothes off.

Ask to meet the provider in an office instead of an exam room so you can communicate your needs. Prepare a script if you’re worried you won’t be able to get it all out. You can start it out with:

“I’ve had some really bad experiences in health care and so I have a really hard time in health care settings.”

You don’t have to give them any more detail than that unless there is something specific you need them to understand.

“I want to make this as easy as possible for both of us, but in order to do that I need….”

And then tell them what helps you, if you know. For example, you could say, “I need:

You to tell me everything you’re doing before you do it

The whole process to go a lot slower than you normally go

To not be uncovered/naked anymore than is absolutely necessary

To be able to communicate with you even if I can’t speak

Even if you don’t know exactly what will help you, don’t let that stop you from having this conversation. I can guarantee you will not be the first traumatized person the provider has encountered. They might even have some trauma-taming trips up their sleeve.

4. Don’t Dis Dissociation

For some folks, the sensation of being disconnected from their body can be really troubling, or it can lead to more problems like self harm. But if you’ve developed tools and methods to keep yourself safe and you need to leave your body a bit to get through an exam, that might be a positive coping skill for you.

5. Soothe Your Senses

If dissociation either feels or is dangerous for you, you probably already have some ways to keep yourself grounded. Some folks repeat the day, date and location to remind themselves of where they are and what’s happening. If you don’t want the harsh looks this particular behavior will cause in a crowded waiting room, bring a notebook and write the same thing.

If you get triggered by the certain smells within the healthcare environment, bring essential oil (I like grapefruit) and put a drop or two under your nose.

6. Travel with A Team

No one should be alone in the hospital ever, under any circumstances. Although this is less of a rule and more of a suggestion in outpatient care, often good support can mean the difference between completing an appointment and running out of the waiting room before you’ve been seen.

Not that you would ever do that.

A partner might be a good support in health care matters, but if you’ve been battling over whether or not you’re going to the doctor, sometimes it can be better to take a friend. In fact, having a health care buddy is a great resource; they can go with you to your appointments and you can return the favor.

If you’re doing ongoing work with a mental health professional, it might even be an option for them to come with you if you need that specific type of support.

7. Find a slightly different way to talk to yourself.

Often we compound our trauma reaction by berating ourselves for not getting healthcare when we need it, even though our difficulty with getting care makes perfect sense. If you’ve been traumatized at a gyn office, why wouldn’t you get short of breath and have a pounding heart just thinking about going back?

You’re not going to go from “dammnit, why don’t you just get a pelvic exam already, you jerk” to “I’m good enough, I’m smart enough and doggone it, people like me” but you can do some harm reduction. Talk to yourself just a little bit kinder.

Instead of saying “WTF! I’m 29 I can’t believe I haven’t had a pelvic exam”

Try “Yup, in a perfect world I should have done this already. It ain’t a perfect world, I am doing it now.”

Instead of saying “I’ crazy, no one is this afraid to go to the doctor”

Try “Yes, this feels crazy, and lots of people are afraid of lots of different things.”

There are times in a medical encounter you will need to be unclothed or at least less clothed. Even the most adept provider can’t do a gyn exam on someone wearing denim overalls. But when you’re sitting around in a paper gown the size of a napkin waiting for someone to take your blood pressure? That’s for provider convenience.

Bring a larger than you flannel shirt (don’t act like you don’t have one) or other oversized garment to slip on or off in between encounters and you’ll feel less exposed and hopefully less triggered.

Just don’t expect them to let you wear a hoodie when you get a mammogram.

At least that’s what I, um, heard.

BIO: Kelli Dunham is a nurse, stand up comic and the author of five books of humorous nonfiction including Freak of Nurture (Topside Press, 2103) which Kate Clinton called “laugh out loud outrageous storytelling.” Kelli travels the country spreading her humorous gospel of medical self advocacy for the LGBT community, speaking frequently to colleges and community groups and emceeing the occasional livestock auction.